OB: Postpartum Assessment and Nursing Care

Management - Lab tests: cultures of the vaginal secretions, WBC- show leukocytosis, RBC Sed rate would be increased, the RBC count could show anemia. - Will have IV access- requiring broad spectrum antibiotics: Penicillin cephalosporin clindamycin Nursing actions - Use aseptic technique for all procedures - Hand hygiene - Sterile gloves are used in labor and birth - Clean gloves during postpartum care - Comfort measures > Warm blankets > Cool compresses - Nurse will be collecting vaginal and blood cultures for the patient suspected of this Infection - Because of pain associated with this infection - analgesics can be anticipated - Educated to take all medications as prescribed > Need to notify provider if development of watery bloody diarrhea or any other complications.

Endometritis Management and Nursing Care

- Some of the changes that occur during pregnancy are being reversed to reflect the nonpregnant state. Some changes such as lactation are continuing to progress. Postpartum begins at 4th stage of labor and continues 6 weeks. Immediate after delivery - assess for hemorrhage- fetus no longer impedes blood flow returning from lower extremities- there may an increase cardiac output - With skin to skin contact between infant and the mother - as well as early breastfeeding- there is stimulation of the endogenous oxytocin production. This oxytocin assists in contracting the uterus. Where by blood flow is decreased. Recovery from anesthesia may hinder this mother's ability to sense any initially changes in her status which puts her at greater risk for hemorrhage. - Begins with the birth of the placenta and continues for 6 weeks after delivery - Rapid physical, social, and emotional adaptation - Assessment BUBBLE HER- it is our goal to prevent severe blood loss and hemorrhage.

Postpartum Period

- The primary nursing focus for postpartum care is prevention and early identification of complications - The most common causes of severe maternal morbidity and mortality postpartum are preventable. - Most postpartum complications occur after discharge, yet only 60% of women receive follow-up care. - Nursing care should focus on prevention, early identification, and éducation.

Postpartum Physiological Assessments and Nursing Care

Immediate recovery from childbirth when homeostasis is reestablished. - Vital signs begin to return to pre-pregnancy levels - Initial bonding/breastfeeding - Recovery from anesthesia

L&D Stage IV

- Complications that can occur up to 28 days following child birth or following spontaneous or induced abortion -- Fevers of up to 100.4 degrees or higher after the first 24 hours or for 2 days during the first 10 days of the postpartum period is indicative of post-partum infection

Postpartum infection:

Assess: - Frequency and total output Retention vs diuresis - Dysuria (trauma vs infection) - Signs of infection Nursing interventions - Assist to void (catheterize prn) - Encourage fluids - Kegel exercises

Bladder Assessment What to Assess For and Nursing

Urinary Tract Infections

common in the postpartum patients. Secondary to bladder trauma which occurred in delivery or break in sterile technique during catherization

Endometritis

infection of the uterus- specifically the lining or the endometrium. Most frequently occurring infection. Typically, it begins around the 2nd to 5th day postpartum. Starting as a localized infection at the placental insertion site and then spreading over the entire uterine endometrium.

Postpartum Depression

#1 complication of postpartum period (occurs with in 6 months postpartum)

- You want to be sure to assess patient elimination process and patterns. - Check to ensure that the patient voids within the first 6-8 hours after delivery. - Check for distended bladder within the 1st few hours after delivery. - A distended bladder can interfere with uterine involution. - Used prescribed pain medication before elimination or pour warm water over perinium to eliminate fear of pain. - Anticipate need for urinary catheterization if the patient cannot void. - Check with physician about amount of urine to be removed from bladder. - Is cath yields greater than 1000ml urine, expect to leave catheter in place. To great of fluid loss at one time can lead to shock. - If catheter is left in place, check with HCP about clamping the catheter and releasing every2 hours to help improve bladder tone.

Bladder Assessment

- We want to encourage patient to have a bowel movement within 2 days after delivery to avoid constipation. - Urge increased fluid and refridge intake???____ Don't know what she said here______. - Assist with alleviating maternal anxiety from or damage to episiotomy site. If necessary, administer a laxative, stool softener, suppository or enema as ordered. - Be aware that nothing should be inserted in the rectum of a patient with a 4th degree laceration. Stool softeners and laxatives commonly used in postpartum clients include: - Docusate calcium - Docusate sodium - Magnesium hydroxide

Bowel Assessment

Auscultate abdomen for: - Bowel sounds - Flatulence Assess - Frequency and Consistency of stools - Hemorrhoids Interventions: - Medications - Stool softener - Laxative - Ambulation - High fiber high protein diet - Increase fluid intake

Bowel Assessment Auscultate and Assess

- Should occur every shift. On the 1st- 2nd day postpartum - the breast should be soft. - By the 3rd day - the breast may be warm or firm indicating that the breast are filling. By the 4th or 5th the breast may feel hard, tense, tender, and appear redden and enlarged this would indicate engorgement. - Check nipples for cracking fissures or soreness. - Advise patient to wear a support bra to maintain shape and enhance comfort. - Avoid bras with underwire.

Breast Assessment

Assess for: - Size, shape, symmetry - Colostrum vs. milk, engorgement - Redness, heat, pain - note any redness, tenderness or engorgement. - Cracked/fissured nipples Provide comfort measures - Ice, - Warmth - Support bra - Cabbage leaves - Pain meds

Breast Assessment What to Assess For:

- Bonding: occurs immediately postpartum when close contact occurs, allows attachment - Attachment: parent and infant come to love and accept one another - Claiming: identifying of "likeness" of family members - Communication between parents and newborn -- Touch (fingertip, stroking, enfolding) -- En face (mutual gazing, 8 inches apart) -- Reciprocity (responds to clues) - The entire extended family will be involved in bonding and attachment. - Claiming or identifying lightlessness of family members is a common characteristic of these developmental tasks. - Various communication skills will be developed, especially by the primiparous mother or any younger aged siblings.

Developmental tasks of the family

- Nurses should assist the postpartum woman and her family in developing these bonding and attachment and communication skills. - Nurses can assist siblings adapt/accepting to the newborn by including siblings in demonstrations and discussions about the baby (at their own developmental age level). -- Sibling typically don't like sharing parents. Reactions depend on age and total number of siblings. As well as preparation by parent -- Regression of sibling is normal reaction to birth of newborn. - Grandparents may be well meaning but offer too much advice and control. -- Nurses can redirect the decision making of infant care back to the parents.

Developmental tasks of the family Nursing Interventions

- Mothers undergo psychological adjustments in the Postpartum period. - Reva-Rubin- a researcher - examined maternal adaptations to child birth in 1960s. She identified 3 phases that can help understand maternal behavior after delivery. - Each phases has a specific time span and women progress through the stages sequentially. - Because today's hospitalizations have shortened, women appear to move through stages more quickly, possibly experiencing more than one phase at one time

Emotional maternal Developmental Tasks

Postpartum blues - Sad/Crying - Mood swings - Decreased appetite - Insomnia - Anger - Interventions include patient/family education, appropriate referrals, medications, encouragement, cultural sensitivity - Throughout the assessment of the postpartum client the nurse should engage the woman so as best to assess her emotional status. - Be sure to notice/Watch for signs/ symptoms of postpartum blues. If positive the nurse should notify health care provider. So provider can distinguish between blues and depression. - Educate the family about normal versus prolonged symptoms as the woman may not be able to distinguish herself and may not seek treatment. - Encourage rest to induce stress in this client

Emotions:

Risk factors - Retained placenta fragments - Manual extraction of placenta - Prolonged ruptured of membranes - C-section birth - Chorioamneitis - Internal fetal monitoring - Operative vaginal births Assessment - Pelvic pain - Chills - Fatigue - Loss of appetite - Elevated temperature of 100.4 for 2 or more days - Uterine tenderness and enlargement - Dark , profuse lochia - Lochia may have foul smell and be purulent - Tachycardia

Endometritis Risk Factors and Assessment

- Assess site every shift to evaluate healing. - Be aware the edges of episiotomy are usually sealed 24 hours after episiotomy. - Note ecchymosis, hematoma, erythema, edema, drainage, or bleeding from sutures, foul Oder, or infection. - Position patient comfortable when inspecting episiotomy. - Position patient with a mediolateral episiotomy on that side to provide better visibility and less discomfort. - Potion patient with midline on the side or the back during assessment. - During assessment of episiotomy is also good timing to assess rectal area- note number and appearance of any hemorrhoids present.

Episiotomy/perineum Assessment

Assess/Sims position - REEDA - Pain - Cause of urinary/bowel dysfunction - Midline/lateral (1st-4th degree) Interventions - Sitz baths - Perineal wash - Ice pack - Medications

Episiotomy/perineum What to Assess

*H*oman's: (DVT) pregnancy is a *h*ypercoagulable state. - Secondary to hormonal shift, trauma, bedrest - Assess for calf pain with dorsiflexion of foot, also swelling, discoloration, pedal pulses, dtrs - If negative, encourage ambulation, leg exercises. ALPS, support hose if ordered - If positive signs/symptoms, call MD, assess for PE - Though Homan's sign is not as reliable as an assessment for DVTs it is a reminder that postpartum women are at risk for emboli related to hormonal shifts, immobility, and injury to lower extremities as well as clotting disorders (HELLP, DIC). - Be sure to include an assessment of lower extremities such as checking for pulses, edema, redness/tenderness. - Post c/section patients should have compression boots in place until full mobilization - Ambulate as early as possible post-delivery to minimize risks of developing DVT - Teach her not to cross her legs/feet or wear constrictive stockings. - If positive signs are present on assessment the provider should be notified with the recommendation for medical treatment.

Homan's Assessment

during pregnancy, women are considered in a hypervolemic state. This hypervolemia state helps to reduce risk of blood loss at time of delivery. Average blood loss for vaginal delivery is around 500 ML because of hypervolemic state, that blood loss typically does not effect maternal status. Stroke volume and cardiac output increased in the first few postpartum hours and is elevated for about 28-48 hours post delivery. There is then a return to normal output before day 10 postpartum. Increased amounts of circulating clotting factors normally present during pregnancy. These extra clotting factors places postpartum client at very high risk for thromboembolism. The clotting factors slowly decrease over the 1st 2 weeks post partum. During the 1st week postpartum - women are higher risk for experiencing orthostatic hypotension due to decrease vascular resistance within the pelvis

L&D Stage IV Intro

- Assess vital signs as ordered- frequency depends on orders set as well as your facility policy and procedures. Once vitals are stable- the mother can be transferred to postpartum unit- this typically takes about 2 hours before transfer can occur ◦ Q15min x 4 ◦ Q30min x 2 ◦ Q4hr x24hr - Assess uterus for position/consistency - Assess lochia - Assess perineum for lacerations - Assess bladder - if uterus is boggy or displaced- common cause is bladder distention- assist women to void- if she is unable you may have to have a catheter. Pain from perineal injury may also effect voiding spontaneously. Recovery from anesthesia ◦ Respirations/lung fields/level of consciousness ◦ Motor ability - Provide comfort measures- new mother may become chilled and shake vigorously- believed to be due to loss of heat from fetus. Comfort measures as well as pain from contractions or episiotomy should be dressed appropriately ◦ Nonpharm for comfort- warm blanket, ice packs to perinium ◦ Pain medications as ordered ◦ Always encourage non pharm measures first. - Assist with bonding - Continued assessments

L&D Stage IV Nursing Actions:

- The discharge that occurs after delivery. - Occurs due to sloughing of uterine decidua. - You assess lochia with fundus every 15 minutes during the 1st hour after delivery. Every 30 minutes for the next 2-3 hours , then every hour for next 4 hours. - And then every 4 hours for the rest of the postpartum day. After the first 24 hours , lochia will be assessed every 8 hours until the patient goes home. Watch for continuous bright red blood - this may indicate cervical or vaginal laceration - ADDITIONAL medical attention is necessary

Lochia Assessment

- Lochia that saturates a sanitary pad within 45 minutes usually indicates an abnormally heavy flow. Weight perineal pads to estimate amount of blood loss. Be sure to look under buttock where blood may be pulling - Lochia discharge may diminish after a C-section. You want to be alert for an increase in Lochiel flow on rising. A heavy flow may occur when patient first arises of bed due to pooling of lochia in vagina. Be sure to evaluate amount of clots. Numerous large clots=evaluation as they may interfere with involution - Remember breast feeding exertion may increase Lochiel flow Know lochia may be scant but should never be absent as this may indicate Postpartum infection. - Amount of lochia varies- can be compared to menstrual flow - saturating pad in less than an hour minutes is considered excessive - the physician should be notified. Amount of Lochia (methods to assess) - scant (1-2 inch. stain), - light (between 2-4 inch stain), - moderate (4-6 inch stain), - heavy (pad sat. w/in 1 hr), - excessive (pad saturated with in15 minutes - Risk of clots - Determine source (lochial vs nonlocial)

Lochia Assessment of Amount

Rubra (consist of blood and decidua)- Lochia rubra is vaginal discharge for the 1st 3 days after delivery. Fleshy odor- blood with small clots - Red, lasts 3 days Serosa (consist of blood, serum, leukocytes) - vaginal discharge that occurs during days 4-9. It is pinkish or brown with serosanguinous consistency. A fleshy Oder is normal - Pink, lasts day 4-10 Alba (consist of leukocytes, epithelial cells ,mucous)- yellow to white discharge that begins around 10 days after delivery can last 2-6 weeks. Note - any foul odor , foul smelling lochia may indicate an infection. Yellow to white, lasts up to 6 weeks

Lochia Color Assessment

- Refusal to hold infant - Angry/disappointed expressions > Verbal > Facial/nonverbal - Avoidance - Ignoring hunger cues, being angry with the infant for interrupting sleep, etc. are indicators that mother and/or family members are not bonding/attaching to the infant. HCP should be notified. - All family members have new roles to integrate into their life's. Maladjustment can appear in P.P period. Nurse should watch for maladjustment, not only on the mother's part, but also with other family members, Sometimes support groups are necessary. Case management and social services are good

Maladjustment: Signs include:

- explain procedure and provide privacy- next wash hands and put on cloves. Next have the patient urinate, If she is unable to urinate anticipate need to catharize her. Then lower the head of bed until patient is supine or slightly elevated. Expose abdomen for palpation and perineum for inspection. Watch for bleeding, clots, and tissue expulsion while massaging uterus. Gently compress uterus between both hands to evaluates firmness. A full time pregnancy stretches ligaments supporting uterus, placing uterus at risk for inversion during palpation and massage. The guard against this, place one hand on the patients abdomen at the symphysis pubis level- this steadies the fundus and prevents a downward placement. Then , put the other hand at the top of the fundus cupping it. Note the level of the fundus above the umbilicus in cm or finger widths. If the uterus seems soft and boggy - gently massage fundus with circular motion until firm. Without digging into the abdomen, gently compress and release. Always supporting lower uterine segment with other hand. Observe vaginal drainage during massage. Massage long enough to produce firmness but not discomfort. • Fundal massage • Breast feed • Tocolytics • Empty bladder • Call MD > Surgery, vaginal pack > Blood products

Nursing interventions- before palpating uterus

- Fathers need to discuss labor and delivery experience. The father of the newborn may feel left out when attention is given to the neonate and the mother. Father's usually have less experience and knowledge of infant care- thus need to be involved in any teaching plan. The father may become jealous of the mother and neonatal bond. The father has some tasks as well as the mother in adjusting to the new baby. - Stage I-expectations, willingness but with preconceived notions - Stage II-reality, may have ambivalence - Stage III-transition/mastery, makes adjustments - Engrossment

Paternal Developmental Tasks

- Significant loss of blood after giving birth - Number one reason for maternal morbidity and death - 500 vaginal - 1000 c-section

Postpartum Hemorrhage:

Contraception/menstruation - Use of water based lubricate is needed and may be expected for 6 months - This client can perform kegel exercises to help strength perineal muscles Medications - The postpartum patient should request assistance for getting out of bed for the first couple times to minimize dizziness and fainting from medications, blood loss, or decrease food intake. - Referrals (WIC, support groups)

Postpartum Teaching: Maternal - Contraception/menstruation - Medications

- Change perineal pads frequently - Monitor the lochia flow - Immediately reporting lochia with foul smell, heavy flow, or clots - Encouraged to report lochia that changes to bright red color - Instructed to perform perineal care with each void, bowel movement, and pad change - Sitz baths are used 3-4 times daily as directed by HCP - Encouraged to take daily shower to relieve discomfort of normal Postpartum diaphoresis - Sexual activity and contraception - follow HCP instructions on return. Most couples can resume 2-4 weeks after delivery. Cessation of vaginal bleeding and healing of episiotomy are necessary before sexual activity can be resumed. - Breastfeeding is not a reliable form of contraception. Thus these women should be instructed and encouraged to choose other options of birth control. - Weight lost can be expected - around 5 pounds from diuresis in first P.P period. In addition to 12 pounds typically lost after delivery - Return to pre pregnancy weight can be expected 6-8 weeks post delivery if client had normal weight gain. - Encourage to get adequate amounts of rest, naps during day, rest when infant is sleeping - Begin exercise when allowed by HCP- start slowly and gradually increase amount - Sit with legs elevated for about 30 minutes if lochia increases or lochia rubra returns > Either of those may indicate excessive activity - if excessive vaginal discharge persists, notify HCP - Abdominal muscle tone can be expected to increase around 2-3 months after delivery Consider nutrition education - Increase protein or caloric intake to restore body tissues - Expect increased thirst because of postpartum diuresis - If client is breast feeding- drink 10 ounces of water everyday - Drink plenty of fluids-esp. water - Eat foods high in fiber. Elimination education: - Be told not to ignore urge to defecate or urinate - Notify HCP with burning or pain on urination - Use stool softeners as prescribed - Use witch hazel compress, sitz baths, or anesthetic meds to relieve discomfort of hemorrhoids - Lie on the left side with upper leg flexed to help reduce discomfort of hemorrhoids Discomfort measures for perineal - Ice packs for first 8-12 hours- helps to minimize edema - To relieve discomfort from enlarged breasts : Wear support bra Apply ice packs Take prescribed medication If breast feeding - frequent meals, apply warm compress, express milk manually from breast to relieve engorgement - Educate her not to be alarmed by mood swings or bouts of depression = normal - Mood swings typically occur in 1st 3 weeks after delivery and subside from 1st 1-10 days. - Make a follow up appointment from 4-6 weeks after delivery.

Postpartum Teaching: Maternal - Signs of infection - Self-care instruction - provided to new mothers:

a new mother experiences may changes. Knowledge of these changes are essential to guiding interventions. Nurse places a key role in providing care and teaching

Postpartum adaptation

BUBBLE-HER - Breasts - Uterus - Bowel - Bladder - Lochia - Episiotomy - Homan's - Emotions - Related Labs

Postpartum assessment: Focus Nursing Assessment

- Occurs within first 2-3 weeks postpartum - Sign/symptoms - Severe sadness - Paranoia - Hallucinations - Delusions - Obsessive behaviors - Disoriented - Confusion - This client may harm self or her infant - Do not leave alone if she has any of these symptoms - Family should Seek medical treatment immediately

Postpartum psychosis Signs and Symptoms

- Taking in (1-2 days), dependent- passive - direct energy towards herself instead of towards her baby. May relieve labor and delivery to integrate process into life. May find it difficult to make decisions. - Taking hold (10days+), dependent/independent- days 2- 7!!!! - more energy - demonstrating independent and self care activities. Accepts increasing responsibility for new born. May be receptive to infant and self care education. May express lack of confidence for caring for baby. - Letting go, interdependence (infant, partner, etc.) - day 7 and beyond. She is readjusting relationships with the family such as reassuring or assuming mothers role. Assumes responsibility for newborn. Recognizes newborn is separate from self. May experience depression.

Reva Rubin

- First (Taking in) she will be dependent and self focused. She may review her L&D experience and how she performed. She may be fatigued and want to assign newborn care to the nursery or to a family member. This stage usually is short lived, about 2 days or less (about the time mother is discharged). - The second phase is (Taking Hold) and last 7-10 days (mother will be 1-2 weeks postpartum). Here mother shows more independence, is beginning to integrate child care responsibilities in her own activities of daily living. She may need others to prepare meals, buy groceries, and do household tasks. Remember there are cultural differences and some cultures assign these duties for longer periods than others. - The third phase is (Letting Go) this is Reva Rubin's final postpartum phase where the mother resumes her role in her family (with other children and with her spouse/partner). She views the infant as separate from her but there is an interdependence between her and the infant and other family members.

Reva-Rubin as identified three maternal developmental stages that she must navigate through during the normal postpartum period.

Crying Intense mood swings Anxiety Fatigue Weight loss Irritability Insomnia Flat affect - Most who have p.p depression have experienced a History of depression, isolation, complication of pregnancy/birth

Signs of Postpartum Depression

- One sign that he is accepting his new role is "engrossment". This is a term reserved for the father as he focuses on the newborn in awe. He has ideas of how life will be but soon reality sets in as he is called on to take more responsibility; ambivalence may occur. - Usually, he makes the adjustments and transitions into his new role. - However, paternal maladjustment and depression can occur, especially if the mother is having emotional difficulty and he is being asked to hold the family together (men are traditionally expected to "keep it all together".)

The father of the baby also has some developmental tasks.

Management - Diagnostic - UA - looking for WBC, RBC, protein, and bacteria > Could expect culture and sensitivity to be ordered Nursing actions - Collection of urine - Admin antibiotics - Provide an education of importance of completing entire prescription - Tylenol for discomfort and pain associated with UTI - Proper perineal hygiene is important!! - Wipe front to back - Increase her fluid intake to at least 3000ml/day so that the urine is diluted and bladder is flushed.

Urinary Tract Infections Management and Nursing Actions

Risk factors - Post-partum hypotonic bladder - Urinary stasis and retention - Epidural anesthesia - women who have epidural tend to lack the ability to tell when the bladder is full and when they need to empty it until full sensation comes back which leads to retention and stasis - Frequent pelvic exams - History of UTI - C-section birth Assessment - Report urgency, frequency, dysuria, and discomfort in the pelvic area when UTI is present - Experience fever and chills - Malaise - Changes in vitals such as elevated temperature - Urine can be cloudy, blood tinged, odorous, sediment - Urinary retention will be present - Pain in the in the suprapubic area as well as cosatubural angle pain if polynephritis is present???

Urinary Tract Infections Risk Factors and Assessment

- Check tone and location of the fundus- the upper most portion of the uterus every 15 minutes for the 1st hour after delivery. Every 30 minutes for the next 2-3 hours. Every hour for the next 4 hours. And then every 4 hours for the rest of the postpartum day. Then every 8 hours until the client is discharge. - The involuting uterus should be midline and firm. The fundus is usually midway between umbilicus and sympatyis pubis 1-2 hours after delivery. A firm uterus helps to control post partum hemorrhage by clamping down on uterine vessels. If the fundus feels boggy, massage it gently. If the fundus doesn't respond, a firmer touch should be used. Because the uterus and supporting ligaments are tender after delivery, pain is the most common complication of fundal palpation and massage. Excessive massage can stimulate myometrium relaxation causing muscle fatigue and leading to uterine atony or inversion. Be prepared to admin oxytocin , ergonovine, or methagin to maintain uterine firmness as ordered. Be alert for uterine relaxation which may result in uterine bleeding. Suspect a distended bladder is uterus isn't firm at the midline. A distended bladder can impeding downward decent of uterus by pushing up and possibly to the side. Evaluate any vaginal bleeding if considered excessive.

Uterus Assessment

Assess placement and consistency - Firm, midline - Boggy /atony (knees flexed, support lower segment) - Massage - Medication - Allow infant to breastfeed - The fundus is usually midway between umbilic and pubis 1-2 hours after delivery. Then 1 cm above or at the level of the umbilicus 12 hours after delivery. And about 3 cm below umbilicus by 3rd day after delivery. This is known as involution of the uterus. The fundus will continue to descend 1cm per day until it isn't palpable above symphysis. Typically this occurs around day 9 after delivery. The uterus decreases to pre pregnancy size 5-6 weeks after delivery. Not from decrease of number of cells, but decrease in cell size. - Remember fundus should feel firm to the touch . Assess involution (1cm every 24 hrs.) > Involution vs subinvolution > Contraction, catabolism, regeneration - 10 days (in pelvis) - 6 weeks (prepregnant state) - You want to be sure to assess for complaints of after pains. These may also be referred to as after birth pains. Multipara is more prone to after birth pain from contractions. These after pains generally last 2-3 days, and may be intensified by breast feeding. Assess for after birth pains - Increased occurrence in: > Breast feeding mothers > Multiparous women > Over distended uterus (macrosomia, multiple fetus) - Treatment Medications Assess for endometritis - Tenderness - Foul odor Assess incision of C-section patients - REEDA

Uterus Assessment What to Assess For

Risk factors - C-section incision - Episiotomy - Vaginal lacerations - Or other trauma wounds to birth canal that occurred during L&D Assessment - Warmth at the site - Erythema - Tenderness - Pain - Edema - Purulent discharge - Separation of the wound at its edges - Evisceration - Temperature greater 100.4 for 2 or more consecutive days Management - Perform wound care - Admin IV antibiotics - Provide or encourage comfort measures Nursing actions - Good hand hygiene is necessary > When changing perineal pads - Be sure to instruct patient to remove pad going from the front of body towards the back - perform hand hygiene prior to and after perineal care

Wound Infections